For patients ≤50 years of age, SRS alone favored survival, in addition, the initial omission of WBRT did not impact distant brain relapse rates. SRS alone may be the preferred treatment for this age group.

Network meta-analysis (NMA) – a statistical technique that allows comparison of multiple treatments in the same meta-analysis simultaneously – has become increasingly popular in the medical literature in recent years. The statistical methodology underpinning this technique and software tools for implementing the methods are evolving. Both commercial and freely available statistical software packages have been developed to facilitate the statistical computations using NMA with varying degrees of functionality and ease of use. This paper aims to introduce the reader to three R packages, namely, gemtc, pcnetmeta, and netmeta, which are freely available software tools implemented in R. Each automates the process of performing NMA so that users can perform the analysis with minimal computational effort. We present, compare and contrast the availability and functionality of different important features of NMA in these three packages so that clinical investigators and researchers can determine which R packages to implement depending on their analysis needs. Four summary tables detailing (i) data input and network plotting, (ii) modeling options, (iii) assumption checking and diagnostic testing, and (iv) inference and reporting tools, are provided, along with an analysis of a previously published dataset to illustrate the outputs available from each package. We demonstrate that each of the three packages provides a useful set of tools, and combined provide users with nearly all functionality that might be desired when conducting a NMA.

In older adults, exposure to ambient nitrogen dioxide and PM(2.5) was associated with hospitalization for community-acquired pneumonia.

BackgroundIdiopathic pulmonary fibrosis (IPF) is an interstitial lung disease associated with high morbidity and mortality. Effective treatments for IPF are limited. Several recent studies have investigated novel therapeutic agents for IPF, but very few have addressed their comparative benefits and harms.MethodsWe performed a Bayesian network meta-analysis (NMA) to assess the effects of different treatments for IPF on mortality and serious adverse events (SAEs). We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) up to August 2015. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach served to assess the certainty in the evidence of direct and indirect estimates. We calculated the surface under the cumulative ranking curve (SUCRA) for each treatment.We included parallel group RCTs, including factorial designs, but excluded quasi-randomized and cross-over trials. Studies were only included if they involved adult (≥18 years of age) patients with IPF as defined by the 2011 criteria and examined one of the 10 interventions of interest (ambrisentan, bosentan, imatinib, macitentan, N-acetylcysteine, nintedanib, pirfenidone, sildenafil, prednisone/azathioprine/N-acetylcysteine triple therapy, and vitamin K antagonist).ResultsA total of 19 RCTs (5,694 patients) comparing 10 different interventions with placebo and an average follow-up period of 1 year fulfilled the inclusion criteria. SUCRA analysis suggests nintedanib, pirfenidone, and sildenafil are the three treatments with the highest probability of reducing mortality in IPF. Indirect comparison showed no significant difference in mortality between pirfenidone and nintedanib (NMA OR, 1.05; 95 % CrI, 0.45–2.78, moderate certainty of evidence), pirenidone and sildenafil (NMA OR, 2.26; 95 % CrI, 0.44–13.17, low certainty of evidence), or nintedanib and sildenafil (NMA OR 2.40; 95 % CrI, 0.47–14.66, low certainty of evidence). Sildenafil, pirfenidone, and nintedanib were ranked second, fourth, and sixth out of 10 for SAEs.ConclusionIn the absence of direct comparisons between treatment interventions, this NMA suggests that treatment with nintedanib, pirfenidone, and sildenafil extends survival in patients with IPF. The SAEs of these agents are similar to the other interventions and include mostly dermatologic and gastrointestinal manifestations. Head-to-head comparisons need to confirm these findings.

Abstract:Cellulosic biofuels present an opportunity to meet a significant fraction of liquid transportation fuel demand with renewable, low-carbon alternatives. Certain ionic liquids (ILs) have proven effective at facilitating hydrolysis of lignocellulose to produce fermentable sugars with high yields. Although their negligible vapor pressure and low flammability make ILs attractive solvents at the point of use, their life-cycle environmental impacts have not been investigated in the context of cellulosic biorefineries. This study provides the first life-cycle greenhouse gas (GHG) and water use inventory for biofuels produced using IL pretreatment. We explore two corn stover-to-ethanol process configurations: conventional water-wash (WW) route and the more recently developed integrated high gravity (iHG) route, which eliminates washing steps after pretreatment. Our results are based on the use of a representative IL, cholinium lysinate ([Ch][Lys]). We find that the WW process results in unacceptably high GHG emissions. The iHG process has the potential to reduce GHG emissions per MJ fuel by ~45% relative to gasoline if [Ch][Lys] is used. Use of a protic IL with comparable performance to [Ch][Lys] could achieve GHG reductions up to 70-85%. The water-intensities of the WW and iHG processes are both comparable to other cellulosic biofuel technologies. Keywords: Biomass pretreatment; Cholinium lysinate; Ionic liquid; Life-cycle assessment; Water intensityIntroduction: